Claim total
$183.62
base $93.39 · payer covered $133.62
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2019-11-05
- Stop
- 2019-11-05
The parties
- Patient
- patient Mirta Nakisha Franecki
- Provider
- provider Amber Yost
- Payer
- payer Medicaid
Record id
05902870-85f1-fda1-b7b6-8c656ba10d98